摘要
目的 探讨儿童心因性疾病的临床特点。方法 对 86例儿童心因性疾病的临床与实验室资料加以分析。 39例行CT检查 ,4 0例行MRI检查 ,75例次行脑电图检查 ,另外还进行了肌电图、脑脊液、肌酸磷酸肌酶等检查。结果 86例中男 4 4例 ,女 4 2例 ;城市 6 2例 ,农村 2 4例。发病年龄为 4 7～ 14岁 ,其中 7～ 12岁 81例 (94 % )。从发病到确诊的时间为 1～ 2 9d 2 9例 ,1～ 12个月 38例 ,1～ 2岁 9例 ,2～ 8岁 10例。发病诱因明确者 5 9例 (6 9% ) ,其中学习负担过重 2 4例 ,躯体疾病后和家庭环境不良分别为 18例 (2 1% )、6例 (7% ) ,诱因不明 2 7例。临床主要表现为瘫痪 2 3例 (2 7% )、抽搐13例 (15 % ) ,其他如头痛、晕厥、感觉异常、头晕、幻视等。曾被误诊为癫 15例、病毒性脑炎 8例、周期性麻痹 5例、急性感染性多发性神经根炎 4例、病毒性心肌炎 3例、发作性睡病、风湿热、过敏性紫癜、静脉炎、周围神经脱髓鞘病变、急性小脑共济失调、直立调节障碍、血管迷走性晕厥、多发性抽动、脊髓炎各 1例。所有辅助检查未见阳性指征 ,均除外器质性疾病。结论 儿童心因性疾病并不少见。学习负担过重是首发诱因 ,其次是躯体疾病后和家庭环境不良。临床表现多样 ,易于误诊 。
Objective To elucidate the clinical characteristics and the diagnosis of psychogenic disease in childhood. Methods The clinical features of psychogenic diseases in 86 children were analyzed. CT, MRI and EEG including Video EEG, 24 hours EEG and conventional EEG were done. Other laboratory examinations such as EMG, CSF, CPK, etc. were also done on some cases. Results Totally 86 cases (44 males and 42 females) were studied. Among them, 62 cases lived in urban areas and 24 cases lived in rural areas. The onset of the disease in children was between 4.7 and 14 years old. And 81 cases (94%) were at the age of 7 to 12 years old. The duration from the onset to the diagnosis of the diseases were 1-29 days in 29 cases, 1-12 months in 38 cases, 1-2 years in 9 cases and 2-8 years in 10 cases. Fifty nine cases (69%) had known factors of inducement. Among them, 24 cases (28%) were due to the heavy load of school work, 18 cases (21%) related to the physical disease prior to the current status and 6 cases (7%) due to the bad relations between their parents. The other 27 cases had no definite factors. The patients manifested as paralysis ( n =23, 27%), convulsion ( n =13), headache, syncope, sensory disturbance, dizziness, visual hallacination, etc. The patients were misdiagnosed as epilepsy in 15, viral encephalitis in 8, periodic paralysis in 5, acute inflammatory polyradiculoneuritis in 4, viral myocarditis in 3, narcolepsy in 1, rheumatic fever in 1, anaphylactic purpura in 1, phlebitis in 1, peripheral nerve demyelination in 1, acute cerebellar ataxia in 1, orthostatic regulation disturbance in 1, vasovagal syncope in 1, Tourette syndrome in 1 and myelitis in 1 case, respectively. All the examinations were negative, which helped us to exclude other organic diseases. Conclusion The psychogenic diseases in childhood were not rare. The heavy load of school work was the most important inducing factor, then the physical diseases and the bad family relations. The clinical manifestations were various, and they were likely to be misdiagnosed. Pediatricians should pay great attention to the diagnosis of psychogenic diseases in children.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2002年第5期263-265,共3页
Chinese Journal of Pediatrics
